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General NPI Number Information
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NPI Number | 1962053728
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Entity Type | Organization
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Legal Business Name | OPTIMUM CARE MEDICAL GROUP
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 3908 SW 137TH AVE
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City | DAVIE
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State | FL
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Zip | 33330-5712
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Country | US
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Telephone | 786-470-0024
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Fax | 954-806-2484
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Provider Business Mailing Address
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Address Line | 10312 BLOOMINGDALE AVE STE 108 PMB 339
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City | RIVERVIEW
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State | FL
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Zip | 33578-3603
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Country | US
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Telephone | 786-470-0024
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Fax | 786-652-1372
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | RONOEL PENALVER
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Credential | MD
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Telephone | 786-470-0024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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